Ask the experts

Our medical 
editors answer readers’ questions

Colin Kerr

Posted: Thursday, May 18, 2017


Prof Sorcha Ní Dhubhghaill 
University Hospital Antwerp, Belgium

Q. Learning cataract surgery can be really stressful for both the trainee and the teacher. Do you have any tips for trainees to help them create the best environment for learning?
Dr Soosan Jacob MS, FRCS, DNB
Director and Chief, Dr Agarwal’s Refractive and Cornea Foundation (DARCF), Senior Consultant, Cataract and Glaucoma Services, Dr Agarwal’s Group of Eye Hospitals, Chennai, India

A. The most important thing that trainees can do to make learning cataract surgery easier is to prepare themselves for surgery – step by step.
A mental checklist should be prepared from multiple sources which includes didactic learning, watching live surgeries performed by seniors, watching surgical videos and finally performing surgery, step by step, under supervision.
Each has its advantages and disadvantages. Didactic lectures and the excellent reading material available, both in the form of books and online articles, helps trainees learn all about the topic.
However, though some concepts are better explained, some are better understood when seen. Watching live surgery by seniors allows one to see his or her technique of surgery and how problems are handled in real time. Nevertheless, it may not be possible to 
see all types of surgical situations or different methods of management of the same scenario.
Watching surgical videos online is another great technique to observe, as many interesting videos can be watched in a short time.
A combination of these three methods will help the trainees to become successful in the last and most important way of learning, which is performing under supervision, both with simulators as well as on the patient.
All the above measures should help the trainee to formulate a step-by-step plan as to the sequence of events to be followed when things are going as planned, as well as when they are not.
Thomas Kohnen MD, PhD, FEBO
Professor and Chair, Dept of Ophthalmology, Goethe-University, Frankfurt, Germany; Editor, JCRS
in collaboration with Anna Slavík-Lenčová MD

Ophthalmology Consultant (for) Cornea, Cataract and External Eye Disease,
Dept of Ophthalmology, Goethe-University, Frankfurt, Germany
A. It is essential to be well prepared. Hard work pays off. Gain as much possible theoretical knowledge about cataracts, IOLs, phacoemulsification and its possible complications. Attend the phaco-courses and video sessions that are offered at congresses. Read books to increase your knowledge on principles and techniques.
Hands-on training is a necessary step. Nowadays, cataract simulators are useful tools for preoperative preparation. You can train your bimanual coordination, preciseness, and go through all the steps of cataract surgery. It is a perfect tool for capsulorrhexis exercise. You can train your skills, repeating each step of a surgery. After each session, you receive an evaluation. The latest simulators also offer training for complicated situations, and provide a unique possibility to train for actual real-life surgery.
It is important to be cautious about your patient selection for your first surgeries. It is recommended to start with easy cataracts and cooperative patients. Deep-set eyes or narrow lids are not good to start with. Think about anaesthesia (anaesthetic block instead of topical drops if preferred).
Familiarise yourself with your microscope, instruments, and the phaco-machine that you are going to use. Adjust your chair and microscope before a surgery. Record videos of your cases and learn from your mistakes. Complications at the beginning are common; do not lose your courage to improve.
Finally, take the opportunity to watch other experienced surgeons. If you compare how they handle the case, it should help you to improve your own surgery.
Boris Malyugin MD, PhD Professor of Ophthalmology, Deputy Director General (R&D, Edu), S. Fyodorov Eye Microsurgery State Institution, Russia
A. Many great surgeons are perfectionists by nature. That is why observing somebody who is doing things that are generally right, but not as perfect as they have to be, may be really stressful.
To relieve that stress, from both the student and the teacher, it is a good idea to divide the procedure into relatively small but crucial steps (capsulorhexis, irrigation/aspiration, IOL implantation and OVD removal, etc).
These steps are relatively short and do not generate prolonged stress.
On the contrary, during one surgeon session, the student will focus on one certain manoeuvre at a time. By doing it repeatedly 10 to 12 times in a row, the student can master the manoeuvre in a fast and efficient way.